Wk 2, Case 3 - Review

Patient History
18-year-old man with right shoulder pain and decreased range of motion after a fall playing football. Evaluate for rotator cuff tear.

Findings
ROTATOR CUFF:

Supraspinatus: Intact.

Infraspinatus: Intact.

Subscapularis: Intact.

Teres minor: Intact.

Biceps tendon and anchor: Intact.

ACROMIOCLAVICULAR JOINT: Completely ruptured superior and inferior acromioclavicular ligaments and capsule. Full-thickness tear/rupture of the coracoacromial ligament. Extensive heterogeneous high-signal hemorrhagic edema surrounding ligamentous injury. Moderate diastasis and elevation/subluxation of the distal clavicle. No posterior displacement.

Coracoclavicular ligaments: Complete full-thickness tear/rupture involving the conoid and trapezoid portions of the coracoclavicular ligament (completely ruptured coracoclavicular ligament). Slightly increased coracoclavicular distance.

SUBACROMIAL ARCH/OUTLET: Normal positioning of the acromion. No evidence of lateral outlet stenosis or impingement.

SUBACROMIAL/SUBDELTOID BURSA: Unremarkable.

GLENOHUMERAL JOINT: Articular surfaces: No high-grade chondromalacia of the glenohumeral articular surfaces.

GLENOID LABRUM: No traumatic or displaced labral tear.

BONES: No acute fracture or evidence of glenohumeral dislocation injury. The humeral head is centered within the glenoid.

MUSCLES: Muscle edema within the anterior proximal deltoid muscle/myotendinous unit origin (grade 1 muscle/myotendinous strain injury). Small partial-thickness tear of the distal trapezius insertion adjacent to the distal clavicle, with diffuse muscle edema extending through the distal muscle fibers, consistent with a grade 1-2 muscle injury. No full-thickness tear or detachment. Otherwise unremarkable muscles.

INTRA-ARTICULAR BODIES: None.

SOFT TISSUE: Extensive soft tissue edema/contusion surrounding the AC joint and lateral/anterior shoulder. Otherwise unremarkable.

AXILLA: Unremarkable

Impressions
1.Grade 3 acromioclavicular joint injury (Rockwood classification system):
2.Ruptured coracoclavicular ligament (conoid and trapezoid portions). Ruptured superior and inferior acromioclavicular ligaments and capsule. 4.Ruptured coracoacromial ligament.
3.AC joint diastasis and moderate distal clavicular elevation (4-5mm).
4.Mildly increased coracoclavicular distance.
5.Grade 1 anterior deltoid strain. Grade 1-2 distal trapezius strain.